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Screening for Iron Deficiency - Abu Osba Medical
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Screening for Iron Deficiency - Abu Osba Medical

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  • 1. Screening for Iron DeficiencyScreening for Iron Deficiency Prepared by Maa’n I.Mesmeh,M.D.Prepared by Maa’n I.Mesmeh,M.D. Moderated by Dr. Yousef Abu-OsbaModerated by Dr. Yousef Abu-Osba
  • 2. Screening for Iron DeficiencyScreening for Iron Deficiency DefinitionsDefinitions EpidemiologyEpidemiology PathogenesisPathogenesis Clinical AspectsClinical Aspects Making the DiagnosisMaking the Diagnosis Laboratory ParametersLaboratory Parameters DietDiet PreventionPrevention
  • 3. Screening for Iron DeficiencyScreening for Iron Deficiency IntroductionIntroduction :: why it is an important health problem ?why it is an important health problem ? Its serious sequelaeIts serious sequelae Its prevalenceIts prevalence Still seen frequentlyStill seen frequently
  • 4. Screening for Iron DeficiencyScreening for Iron Deficiency AnemiaAnemia :: DefinitionDefinition CausesCauses CategorizingCategorizing IronIron :: DepletionDepletion DeficiencyDeficiency Iron deficiency anemiaIron deficiency anemia
  • 5. Screening for Iron DeficiencyScreening for Iron Deficiency EpidemiologyEpidemiology :: WHO estimates : most of the world’sWHO estimates : most of the world’s population are iron deficient , one thirdpopulation are iron deficient , one third have anemia .have anemia . High prevalence in the late 1960s led to theHigh prevalence in the late 1960s led to the introduction of preventive programs .introduction of preventive programs . WIC actWIC act Iron deficiency remains common in theIron deficiency remains common in the developed countries & sever cases stilldeveloped countries & sever cases still occur .occur .
  • 6. 0.00% 1.00% 2.00% 3.00% 4.00% 5.00% 6.00% 7.00% 8.00% 1975 1985 Prevalence Prevalence
  • 7. 0% 2% 4% 6% 8% 10% 12% 14% 1 year 2 year 12-15 years 16-49 years Iron Deficiency Series1
  • 8. 0% 1% 1% 2% 2% 3% 3% 4% 4% Toddlers Adolescent Females Child bearing Age Iron Deficiency Anemia Series1
  • 9. Screening for Iron DeficiencyScreening for Iron Deficiency Attributable factors are different in theAttributable factors are different in the developing countries from developed countries .developing countries from developed countries . Some sectors of the population are moreSome sectors of the population are more susceptible .susceptible . The difference between the infants & toddlers inThe difference between the infants & toddlers in regard to fortification of formula , diet & cow milkregard to fortification of formula , diet & cow milk ingestion .ingestion . The difference between the male & the female .The difference between the male & the female . In the first months of life no role for ironIn the first months of life no role for iron deficiency .deficiency .
  • 10. Screening for Iron DeficiencyScreening for Iron Deficiency PathogenesisPathogenesis :: SiteSite RoleRole Absorption :Absorption : heme & nonhemeheme & nonheme inhibitors of iron absorptioninhibitors of iron absorption enhanced absorptionenhanced absorption absorbability difference between human milkabsorbability difference between human milk (50%) , cow milk (10%) , fortified formula (5%) .(50%) , cow milk (10%) , fortified formula (5%) .
  • 11. Screening for Iron DeficiencyScreening for Iron Deficiency TransportTransport Source & Storage : developing fetus ,Source & Storage : developing fetus , depletion of 50% occurs in the first 4depletion of 50% occurs in the first 4 months , depletion of the stores occur atmonths , depletion of the stores occur at 2-3 months in the preterm2-3 months in the preterm Loss occur in GIT , urine & skin .Loss occur in GIT , urine & skin . Daily needs ( o.8 mg/d : 0.6 growth , 0.2 forDaily needs ( o.8 mg/d : 0.6 growth , 0.2 for ongoing lossesongoing losses
  • 12. Screening for Iron DeficiencyScreening for Iron Deficiency Clinical AspectsClinical Aspects :: S&S depends on the degree of deficiency &S&S depends on the degree of deficiency & on the rate of development of the deficiencyon the rate of development of the deficiency The most frequent sign is pallorThe most frequent sign is pallor 10-15% splenomegally10-15% splenomegally Irritability & anorexia in infants & toddlersIrritability & anorexia in infants & toddlers 45% of sever cases were asymptomatic45% of sever cases were asymptomatic Developmental delay : ? irreversibilityDevelopmental delay : ? irreversibility
  • 13. Screening for Iron DeficiencyScreening for Iron Deficiency Clinical AspectsClinical Aspects :: Other S&S :Other S&S : poor growth , blue sclerae , koilonychia ,poor growth , blue sclerae , koilonychia , angular stomatitis , increasedangular stomatitis , increased susceptibility to infections , GITsusceptibility to infections , GIT symptoms , increased lead absorption ,symptoms , increased lead absorption , pica & plumbism .pica & plumbism .
  • 14. Screening for Iron DeficiencyScreening for Iron Deficiency Making the DiagnosisMaking the Diagnosis :: DDx narrows once classified as microcytic :DDx narrows once classified as microcytic : IDAIDA ThalassemiaThalassemia Lead poisoningLead poisoning Chronic diseaseChronic disease Sideroblastic anemiaSideroblastic anemia
  • 15. Screening for Iron DeficiencyScreening for Iron Deficiency Making the DiagnosisMaking the Diagnosis :: The gold standard for identifying iron deficiency isThe gold standard for identifying iron deficiency is bone marrow biopsy with Prussian bluebone marrow biopsy with Prussian blue staining .staining . Otherwise no single best test to diagnose ironOtherwise no single best test to diagnose iron deficiencydeficiency Hematological & biochemical tests are based onHematological & biochemical tests are based on RBCs features & iron metabolismRBCs features & iron metabolism Biochemical tests detect early iron deficiencyBiochemical tests detect early iron deficiency CHr is a new testCHr is a new test
  • 16. Screening for Iron DeficiencyScreening for Iron Deficiency Laboratory ParametersLaboratory Parameters :: 1) Hematological Markers:1) Hematological Markers: The changes through the spectrum from normal toThe changes through the spectrum from normal to IDA in :IDA in : * Hgb & MCV are late markers & less specific* Hgb & MCV are late markers & less specific * RDW is highly sensitive but has low specificity* RDW is highly sensitive but has low specificity * Reticulocytes : for assessing response to Rx .* Reticulocytes : for assessing response to Rx . * CHr : is the best predictor of iron deficiency* CHr : is the best predictor of iron deficiency among Hgb , MCV , s.iron , RDW & transferrinamong Hgb , MCV , s.iron , RDW & transferrin saturation .saturation .
  • 17. Screening for Iron DeficiencyScreening for Iron Deficiency
  • 18. Screening for Iron DeficiencyScreening for Iron Deficiency Laboratory ParametersLaboratory Parameters :: 2) Biochemical Markers :2) Biochemical Markers : *S.ferritin is the earliest marker of iron deficiency*S.ferritin is the earliest marker of iron deficiency with high specificitywith high specificity *S.iron is not accurate because it is affected by iron*S.iron is not accurate because it is affected by iron absorption , infection , inflammation & diurnalabsorption , infection , inflammation & diurnal variation .variation . *TIBC measures iron-binding sites but affected by*TIBC measures iron-binding sites but affected by malnutrition , inflammation , chromic infection &malnutrition , inflammation , chromic infection & cancer .cancer . *Transferrin saturation (%) = s.iron ÷ TIBC*Transferrin saturation (%) = s.iron ÷ TIBC
  • 19. Screening for Iron DeficiencyScreening for Iron Deficiency Laboratory ParametersLaboratory Parameters :: 2) Biochemical Markers :2) Biochemical Markers : *TfR by immunoassay . It presents in*TfR by immunoassay . It presents in immature reticulocytes . It is early markerimmature reticulocytes . It is early marker & can differentiate between IDA & chronic& can differentiate between IDA & chronic illnessillness *ZPP/heme is an early marker but not*ZPP/heme is an early marker but not specificspecific
  • 20. Screening for Iron DeficiencyScreening for Iron Deficiency
  • 21. Screening for Iron DeficiencyScreening for Iron Deficiency DietDiet :: The dietary history is suggestiveThe dietary history is suggestive IDA in one study defined as :IDA in one study defined as : 1) < 5 servings per week1) < 5 servings per week 2) > 16 oz milk per day2) > 16 oz milk per day 3) Daily fatty snacks , sweets & > 16 oz soda.3) Daily fatty snacks , sweets & > 16 oz soda. In this case the history was 71% sensitive , 79%In this case the history was 71% sensitive , 79% specific , 97% negative predictive valuespecific , 97% negative predictive value
  • 22. Screening for Iron DeficiencyScreening for Iron Deficiency PreventionPrevention :: PrimaryPrimary SecondarySecondary AAP recommendation : Hgb & Hct onceAAP recommendation : Hgb & Hct once between 9-12 months & again after 6between 9-12 months & again after 6 months ( consider risk factor & prevalencemonths ( consider risk factor & prevalence in the population ) also all adolscencein the population ) also all adolscence once between 11-21 years in addition toonce between 11-21 years in addition to all mensruating females annuallyall mensruating females annually
  • 23. Screening for Iron DeficiencyScreening for Iron Deficiency
  • 24. Screening for Iron DeficiencyScreening for Iron Deficiency TreatmentTreatment :: oral iron saltsoral iron salts parenteral ironparenteral iron PRBCsPRBCs Follow upFollow up : increase of 10 g /L after one: increase of 10 g /L after one month of Rx confirms the diagnosismonth of Rx confirms the diagnosis
  • 25. THANK YOUTHANK YOU